Why I wanted to bring baby boxes to the UK

Using a cardboard box to house a sleeping newborn has been traditional in Finland for nearly 80 years. Now, for the first time in the UK, Imperial College Healthcare NHS Trust will be offering boxes to women who give birth at Queen Charlotte’s & Chelsea Hospital as part of a pilot scheme. Here, Karen Joash, consultant obstetrician at Imperial College Healthcare NHS Trust, explains why she wanted to bring this longstanding Finnish tradition to the UK.

In Finland, every women who gives birth is entitled to a box funded by the government containing all the essentials their newborn needs to see them through the first few months of life. This includes bibs, nappies, bathing products, a small mattress and educational material on how to look after their child. The box, which is made from a very thick cardboard, is then used as a bed for the baby to sleep in for the next eight months.

The ‘baby boxes’ have very much become a way of life in Finland and are thought to have contributed to the country having one of the lowest infant mortality rates in the world. It’s an innovation that has also been successfully rolled out in other countries including Canada, but has not yet had much impact in the UK.

As a consultant obstetrician in a country with one of the of highest rates of infant mortality in Europe – around 300 babies a year die in the UK from sudden infant death syndrome (SIDS), also known as ‘cot death’ – I was keen to bring the boxes here to see whether they would work for our parents and help reduce infant deaths.

It is all too easy take for granted the idea that people have the money to buy a separate cot and/or Moses basket, when it is not necessarily the case. The box provides a comfortable and safe sleeping place and, crucially, removes the need for a child to share a bed with their parent, a behaviour which can put a baby at risk of SIDS.

One of the great benefits of the Finnish system is that every mother from all socio-economic backgrounds receives a baby box if they have attended two antenatal classes. This reflects the early origins of the baby box initiative which was to encourage expectant mothers to attend antenatal clinics. The concept has been adapted by places like South Africa, and parts of South Asia, where there are similar efforts to encourage antenatal attendance to manage issues like the transmission of HIV from mother to baby.

Antenatal attendance is not a problem in the UK where classes are generally well attended. It is the postnatal support, in my view, which is lacking. Mothers tend to leave hospital soon after giving birth without the access to a midwife or doctor that may have supported them through their pregnancy. But having a baby is a life-changing and challenging experience with many ups and downs and new things to learn. Women can struggle for months, even years, with breastfeeding, mood or relationships and often have no idea where to turn. Access to advice and support is really important if parents are to start the journey with their new baby in the best way. Education is key for both women and men, helping to ensure the family unit, whatever its constitution, becomes a secure and happy one.

It is here that I believe that baby boxes have the most to offer. The Baby Box Co. boxes that we are piloting at Imperial College Healthcare NHS Trust come with access to a whole network of information and support. Their special ‘Baby University’ website will connect parents to some of the maternity staff they have met at the Trust where they will be able to ask questions and get advice and support. Mums will also be able to talk to other women in their area through a chat forum where they can share their experiences and stories.

The baby box is not a cure-all – it won’t make parenthood easy overnight. But the access to education and support that come with the box is a gift, and is at the heart of why we want to give these boxes to our new mums. During this pilot, 800 new mums of all backgrounds who have their babies at Queen Charlotte’s & Chelsea Hospital will go home with a safe place for their babies to sleep as well as access to educational resources and a supportive community.

We are placing patients at the centre of our project and will allow their responses to define where we develop the project further. We will monitor these babies for the first eight months of their lives and ask their parents to complete a questionnaire about their experiences. We want to find out how the education and support resources that come with the baby boxes affect new parents and their babies. It is our hope that the benefits we find will be rolled out to all women in the UK through all hospitals developing their own free baby box schemes.